Does the use of the Informed Health Choices teaching resources improve the secondary students' ability to critically think about health in Uganda? A cluster randomised trial protocol

Ssenyonga, Ronald; Oxman, Andrew D; Nakyejwe, Esther; Mugagga, Solomon Kevin; Nsangi, Allen; Semakula, Daniel; Chesire, Faith; Mugisha, Michael; Lewin, Simon; Rosenbaum, Sarah; Oxman, Matt; Kaseje, Margaret; Sewankambo, Nelson

doi:10.5281/zenodo.6560218

Cited by 6 publications

(3 citation statements)

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“…26 The three randomized trials that were included were planned collaboratively to ensure a common set of outcome measures and the availability of data to conduct the analyses using individual participant data. [23][24][25] Each trial was conducted in a different country (Kenya, Rwanda, and Uganda).…”

Section: Methodsmentioning

confidence: 99%

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Effects of the Informed Health Choices secondary school intervention: A prospective meta‐analysis

Chesire,

Mugisha,

Ssenyonga

et al. 2023

J Evidence Based Medicine

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AimThe aim of this prospective meta‐analysis was to synthesize the results of three cluster‐randomized trials of an intervention designed to teach lower‐secondary school students (age 14–16) to think critically about health choices.MethodsWe conducted the trials in Kenya, Rwanda, and Uganda. The intervention included a 2‐ to 3‐day teacher training workshop, digital resources, and ten 40‐min lessons. The lessons focused on nine key concepts. We did not intervene in control schools. The primary outcome was a passing score on a test (≥9 of 18 multiple‐choice questions answered correctly). We performed random effects meta‐analyses to estimate the overall adjusted odds ratios. Secondary outcomes included effects of the intervention on teachers.ResultsAltogether, 244 schools (11,344 students) took part in the three trials. The overall adjusted odds ratio was 5.5 (95% CI: 3.0–10.2; p < 0.0001) in favor of the intervention (high certainty evidence). This corresponds to 33% (95% CI: 25–40%) more students in the intervention schools passing the test. Overall, 3397 (58%) of 5846 students in intervention schools had a passing score. The overall adjusted odds ratio for teachers was 13.7(95% CI: 4.6–40.4; p < 0.0001), corresponding to 32% (95% CI: 6%–57%) more teachers in the intervention schools passing the test (moderate certainty evidence). Overall, 118 (97%) of 122 teachers in intervention schools had a passing score.ConclusionsThe intervention led to a large improvement in the ability of students and teachers to think critically about health choices, but 42% of students in the intervention schools did not achieve a passing score.

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Section: Methodsmentioning

confidence: 99%

“…Process evaluations are ongoing, [20][21][22] and 1-year follow-up studies are planned in each country. [23][24][25]…”

Section: Introductionmentioning

confidence: 99%

Effects of the Informed Health Choices secondary school intervention: A prospective meta‐analysis

Chesire,

Mugisha,

Ssenyonga

et al. 2023

J Evidence Based Medicine

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“…The intervention is both an educational and public health intervention in that we intend for it to improve educational outcomes, but also-in the long term, as part of a potential series of interventions-public health outcomes. We are evaluating the intervention in respective randomised trials in Kenya, Rwanda, and Uganda [15][16][17], and process evaluations associated with the trials.…”

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confidence: 99%

Potential adverse effects of an educational intervention: Development of a framework

Oxman

Chesire²,

Mugisha

et al. 2022

Preprint

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Background Researchers often overlook potential adverse effects of educational and public health interventions (increases in adverse outcomes, or decreases in beneficial outcomes, attributed to the intervention). To help us identify potential adverse effects of an educational intervention intended to improve critical thinking about health choices, we developed a framework. We also did a preliminary prioritisation of outcomes in the framework for randomised trials of the intervention, and associated process evaluations. Methods Based on relevant evidence and theory, we developed an initial framework. For feedback on the initial framework, we sent a survey to 70 external experts. We conducted a thematic analysis of the qualitative survey data. After revising the framework based on the survey findings, we interviewed teachers in the context where we are evaluating the intervention, to help identify any effects still missing from the framework, and preliminarily prioritise potential outcomes for the evaluation. Results We received responses from 38 of the 70 external experts (54%), including researchers and others with a variety of expertise within health, education, and design. Overall, the responses were positive. However, they also included critical feedback that led to substantial revisions of the framework’s content and presentation. The revised framework has six categories of potential adverse effects: decision-making harms, psychological harms, equity harms, group and social harms, waste, and other harms. We interviewed three teachers, who did not suggest any missing outcomes. Based on the interview findings, we prioritised three outcomes for the evaluation of the intervention: work-related stress; wasted time or resources; and conflict, in particular between students and family. Discussion As far as we are aware, the framework presented in this article is the first tool of its kind in education research. The framework is a “living” tool, which can be improved upon, as well as adapted. We have used it to inform the development of interview and observation guides, and we are using it to inform the development of outcome measures. Important limitations of the framework include limits to its comprehensiveness, and the use of terminology with different meanings or interpretations depending on the context. Our approach to identifying and evaluating potential adverse effects of an educational intervention can have value to other researchers.

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Teaching Australian high school students to think critically about health claims: a cluster randomized trial

Cusack

Jones

Desha

et al. 2023

Health Education Research

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Making informed health decisions requires knowledge and skills in appraising health claims, and teaching adolescents these skills may prepare them for future decision-making. This cluster randomized trial evaluated the effectiveness of an educational intervention on students’ ability to identify and appraise health claims. Nine Australian high schools (4 control and 5 intervention) were recruited, comprising 974 students (382 control and 592 intervention) in Grades 7–10. Intervention impact was evaluated through baseline and follow-up evaluation. Follow-up mean scores on questions (maximum score of 25) from the Claim Evaluation Tools database (primary outcome) showed minimal between-group difference (intervention versus control: 14.4 versus 13.6; difference 0.8, 95% confidence interval [CI] −1.6 to 3.1; P = 0.52). Change scores were only slightly higher in the intervention group (difference 1.2 [95% CI −0.7 to 3.1; P = 0.21]). Between-group differences for secondary outcomes were also minimal. Most intervention group students ‘trusted’ and ‘liked’ the programme and found the content ‘easy’ and ‘helpful’. Most teacher feedback was positive, some noting challenges of covering content in allocated time and maintaining student engagement. It is unlikely that the assessed educational intervention had a large effect. Future research priorities are suggested.

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Does the use of the Informed Health Choices teaching resources improve the secondary students' ability to critically think about health in Uganda? A cluster randomised trial protocol

Cited by 6 publications

References 0 publications

Effects of the Informed Health Choices secondary school intervention: A prospective meta‐analysis

Effects of the Informed Health Choices secondary school intervention: A prospective meta‐analysis

Potential adverse effects of an educational intervention: Development of a framework

Teaching Australian high school students to think critically about health claims: a cluster randomized trial

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